Prostate cancer remains one of the leading causes of death among men, with more men dying from prostate cancer than women from breast cancer in the UK. Despite this, there is no national screening program for prostate cancer, unlike those available for breast, bowel, and cervical cancers. However, recent reports by cancer charities and prominent health professionals have reignited the debate about the merits of screening men, particularly those at high risk, once they reach the age of 45. Prostate Cancer Research has suggested that screening high-risk men could make financial sense but stresses that better, more accurate tests are needed to justify screening the wider population.
What Are the Current Limitations and Challenges of Prostate Cancer Screening?
Unlike other cancers, prostate cancer lacks a reliable screening test. For men over 50, a blood test called the prostate-specific antigen (PSA) test can be requested through a GP. The PSA test measures the level of a protein released by the prostate, but elevated levels can occur for reasons unrelated to cancer, such as an enlarged prostate, inflammation, or recent physical activity. Moreover, the test cannot rule out cancer entirely, as some men with cancer may still show normal PSA levels.
“There are prostate cancers that are so slow-growing that they will not affect a man’s lifespan,” says a GP. “These are found in one in three men over 50. On the other hand, there are a small number of very aggressive prostate cancers which do move quickly and cause harm,” they add.
This uncertainty with the PSA test has raised concerns about over-diagnosis and unnecessary treatments, leading many to question whether the benefits of screening outweigh the potential harms.
What Are the Arguments For and Against Prostate Cancer Screening?
One of the most contentious aspects of prostate cancer screening lies in the trade-off between detecting aggressive cancers early and the harm caused by diagnosing slow-growing tumours that would never have affected a man’s health. According to the GP, the dilemma arises because prostate cancers vary widely in their progression.
Although clinical trials on screening have yielded conflicting results, some studies have suggested that early detection can save lives, while others have shown only marginal benefits or no benefit at all. For instance, a European trial indicates that prostate cancer screening saves lives, while a UK study showed a more limited advantage. Meanwhile, a U.S. study concluded that screening does not prevent deaths from the disease.
An expert in urology highlights the scale of the challenge, saying, “We need to screen 570 men to prevent one death – that’s a lot of men to counsel.” They note that while early screening can detect aggressive cancers, the risks of over-treatment for low-risk cancers are considerable. Many men diagnosed with low-risk prostate cancer choose “watchful waiting,” or they are subjected to additional tests and treatments that might never have been necessary.
What Are the Psychological and Physical Impacts of Prostate Cancer Diagnosis?
Even when prostate cancer is detected, the journey from diagnosis to treatment can be fraught with complications. For many men, the psychological toll of being diagnosed with cancer is significant. Men with low-risk cancers often have to live with the anxiety of not knowing whether the disease will progress. As a result, one in ten men opts for radical surgery to alleviate this uncertainty, despite the risks of life-altering side effects.
The urology expert explains that these decisions can have long-term consequences: “At the age of 47-48, if we’re talking about testing and diagnosing men at that age, that’s two or three decades of those kinds of symptoms. So I would rather avoid finding low-risk disease.”
Radical treatments, such as surgery to remove the prostate, can leave men with permanent consequences, including the inability to maintain an erection or the need for lifelong incontinence pads. “A third of men who undergo such treatments spend the rest of their life needing a pad because they leak urine,” they add. This illustrates the complexity of the decision-making process, where the risks of over-treatment need to be weighed against the potential benefits of early detection.
Should Screening Be Targeted at High-Risk Groups?
While general screening for all men remains a topic of debate, there is growing support for screening those who are at higher risk of developing prostate cancer. Prostate Cancer Research has proposed that screening should be extended to men aged 45-69 who are at high risk, such as black men and those with a family history of the disease or specific gene mutations. The charity argues that this approach would offer economic benefits when factoring in the costs of treatment and the broader impact on the workforce and carers.
Oliver Kemp, the CEO of Prostate Cancer Research, states, “Finding and treating cancers early outweighs the harms of over-treatment by four times.” This approach, he believes, would lead to better outcomes for those at the highest risk, and could potentially save lives by catching aggressive forms of cancer early.
A consultant urological surgeon also supports targeted screening. They advocate for PSA testing at 40 for black men, who have double the risk of prostate cancer compared to other men, particularly those with a strong family history of the disease. However, they also acknowledge the difficulties in determining who would benefit most from early screening.
“We can do a lot better than we are currently doing,” the consultant adds, emphasising the need to provide better early diagnosis options for high-risk men. They note that black men, in particular, face challenges due to naturally higher PSA levels, which can complicate their diagnosis and treatment.
What Does the Future Hold for Prostate Cancer Screening and Testing?
In the ongoing search for a better prostate cancer screening method, much of the focus has been on refining existing tests and technologies to reduce the risks of over-diagnosis and unnecessary treatments. An expert in urology is leading a new trial, set to begin next year, which will compare the most promising screening technologies. However, the results of this trial could take up to a decade to be fully realised.
In the interim, cancer charities such as Prostate Cancer UK have called for a review of NHS guidelines, arguing that they are outdated and leading to too many men receiving a late, incurable diagnosis. “We need to overhaul dangerously outdated NHS guidance,” the charity asserts, highlighting the need for a more proactive approach to diagnosing prostate cancer at an earlier stage.
How Should Men Make Decisions About Prostate Cancer Screening?
As the debate about prostate cancer screening continues, one thing remains clear: the decision to screen is a highly personal one. The risks and benefits of early detection are nuanced, and what is acceptable to one man may not be to another. Experts agree that the NHS must provide better information to help men make informed choices.
Until more accurate tests and refined screening programs are developed, the balance between early detection and avoiding unnecessary treatment will continue to be a matter of personal choice for many men, particularly those at higher risk. With further research and more focused strategies, it is hoped that prostate cancer diagnosis and treatment will improve in the years to come.
